Introduction
Prior to undertaking this investigation, we should provide a definition of asthma and benign tumor. First, we need to say that asthma is a systemic disease, affecting several, for example, bronchial tubes, lungs, heart, diaphragm, etc (Brown, 2003, p 125). It is a chronic inflammatory disorder of the airways, associated with the following symptoms: variable airflow obstruction and enhanced bronchial responsiveness to a variety of irritants (Brown, 2003, p 2).
In turn, a benign tumor is a local pathology, which normally does not usually influence the entire body; this pathology can be defined as any abnormal swelling or tissue that does not lead to cancer (p 172). Some benign tumors are asymptomatic, which means that there are no signs, indicating this disease, whereas others can be characterized by anemia, pain, and dysfunction (Yabro et al, 2005). These are the key issues we should bear in mind.
Observation
Asthma
During asthma attacks patients normally cough, wheeze, and experience pain and shortness of breath (Levy et al, 2006, p 25). These observable symptoms may vary depending on the type of attack which may be either a mild or a severe one. In such cases, particular symptoms include fast exhaustion, the inability of the lung to function properly, headache, sore throat, nasal congestion, cough, runny nose and sneezing, frequent cough especially at night, shortness of breath and wheezing or coughing after exercise (Levy et al, 2006, p 34).
Benign tumor
The symptoms of benign tumors are much more difficult to detect. Some types of this pathology can be entirely asymptomatic, for example, Warthin’s tumor (Hatch & Shah, 2005). Additionally, the symptoms, which are typical of benign tumors, are often confused with those of other diseases. Patents, who are diagnosed with benign tumor, can suffer from excessive blood loss, headache, obstructed breathing, intestinal obstruction, and compression of organs and blood vessels (Kaufman & Wolchok, 2007). In the majority of cases, patients are seldom aware of their existence. To a large extent, the symptoms depend on the location of the tumor, its type and age.
Pathophysiology
Asthma
- Fluid: a patient, suffering from asthma, has an increased level of fluid in lungs (Murphy, 1998).
- Irritant: an asthma attack can be triggered by a large number of irritants, for example, tobacco smoke, dust, the pollen of some flowers, air pollutants, insect repellants some antibiotics, and even psychological stress. These are the most common stimuli, which may give rise to an asthma attack (Murphy, 1998, p 52).
- Volume changes: normally, asthma is characterized by acute reduction of lung and flow volumes (Murphy, 1998).
- Pressure: asthma is often associated with low blood pressure, especially if we are speaking about acute cases of this disease (Levy et al, 2006).
- Patient fitness, flexibility, mobility, activity level, cognition: The patient’s fitness and mobility depends upon the severity of the attack: if it is severity, he/she will be hardly able to move. (Levy et al, 2006). Cognitive processes are not usually affected.
Benign tumor
- Fluid: Benign tumors sometimes affect the level of some fluids in the human body ( Weiss & Goldblum 2007).
- Irritant: There is no evidence indicating that a patient, who has a benign tumor, suffers from an allergy to irritants. At least, such cases have yet to be identified.
- Volume changes: benign tumors give rise to numerous volume changes of body organs, for instance: urine bubbles, uterus, etc (Kaufman & Wolchok, 2007). However, such cases are not connected with orthopedics.
- Pressure: Benign tumors are often associated with pressure, which causes pain and even dysfunction.
- Patient fitness, flexibility, mobility, activity level, cognition: first, it should be noted that some benign tumors lead to the compression of organs (Kaufman & Wolchok, 2007). In turn, this decreases the mobility and flexibility of the patient. Secondly, we need to say that the cognitive abilities of the patient are not impaired. The exception can be a benign brain tumor.
Assessment and decision-making
When assessing the client I would evaluate several characteristics. One would be an evaluation of the client’s lung function. This would help identify whether the client’s lungs are functioning properly and would help decide on the likelihood of an asthma attack. The other evaluation would be the length of the patient’s breath. Short breaths are common in individuals suffering from asthma. Other evaluations would be aimed at determining whether the client has nasal congestions, running nose or sneezes frequently (Metson et al 2006). These evaluations would help ascertain whether the client has asthma or not.
I would also apply observational and self-report pain scales in order to assess physical condition of the patient. The pain can be measured on the scale from 0 to 10, where 0 means that there is no pain or discomfort. This would enable us to evaluate the effectiveness of the foot orthosis in relieving the pain. For example, if the patient experiences the same pain after wearing the foot orthosis, a further modification of the foot orthosis will be taken to reduce the pain (DiGiovan & Greisberg, 2007, p 12).
This information will subsequently help me in designing the foot orthosis. Along with pain scale, we need to mention sensation measurement. It helps to determine whether the patient would feel comfortable while using the orthosis. While assessing physical conditions, one should also pay extra attention to ROM (range of movement). It can be either passive or active. On the basis of these measurements, medical workers can design the foot orthosis.
I would also try to determine whether the client feels pain, has a lump, inflammation or swelling, compression of blood vessels etc in any part of the body these would help ascertain whether the client has a benign tumor. For this purpose, I would need to take the following steps. First I need to conduct sensation test, which measures relative acuteness of pain (Conrad, 2008, p 267). Normally, it is done with the sharp or blunt end of the safety pin. If there is a loss of sensation in a particular area of the foot, off loading is needed to be placed at metatarsal pads. Additionally, an orthopedist should pay close attention to the skin of the foot.
For example, stiffness and redness indicate that there is intense pressure in this part of the foot. Therefore, off-loading is needed in this particular area (Conrad, 2008). Measuring the size of the benign tumor is also crucial for an orthopedist because it enables him to determine the size of the relief hole in the foot orthosis (DiGiovan & Greisberg, 2007, p 335).
The results of these evaluations would determine my cause of action; in case most of these evaluations turn out positive I would start a treatment program for the client.
Treatment
Given that these evaluations establish underlying symptoms for asthma or asthma, a physician will need to make alterations in the design of a foot orthosis. The most important elements of the design are trim lines, application of forces, materials, and areas of loading and uploading.
The trim line has to be located below the head of the metatarsus and toes, so that polyprophelene could follow the movement of metarso-phalangal joints (ICRS, 2006, p 6). Besides, it will ensure normal blood circulation, and it is of the crucial importance for the patients who suffer from benign tumors, because many of them suffer from the compression of blood vessels (Kaufman & Wolchok, 2007). Overall, we can say that minimal trim lines would be more preferable in this case. As regards the application of forces, we should choose ground reaction force (GRF) control system because it enables more motion of the joint and helps to prevent stiffness (Edelstein & Bruckner, 2002). It ensures perfect biomechanical alignment.
Pressure relief or offloading helps to redistribute pressure of the patient’s weight from metatarsal heads into other regions of the foot. The concept of transferring load away from the benign tumor area is relatively simple; it has been put into practice using the method of making a hole surrounding the benign tumor area in order to alleviate pressure from the area of tumor (DiGiovan & Greisberg, 2007, p 30). The hole could be filled up with silicone. Apart from that, the metatarsal dome or padding will redistribute the pressure of patient’s weight from metatarsal heads to the metatarsal arch and other regions of foot. Moreover, the relief hole will provide an extra relief to the tumor area (DiGiovan & Greisberg, 2007, p 30).
While designing the foot orthosis, one should also pay special care while selecting the type of foam. As a rule, the preference is given to low-density EVA foam, because it is much more flexible, and contributes to better joint motion. We need to say that there is a relationship between the density of foam and the patient’s weight (Hunter et al, 1995). For example, a patient, who weighs 60 Kg would benefit from a lower density of EVA such as 240 EVA, whereas a patient, weighing one hundred kilograms, would require a higher density such as 400 EVA.
Furthermore, we need to say that this foot orthosis should made of aluminum. The thing is that aluminum is a lightweight metal and a person, wearing such orthosis, will have a normal blood circulation and there will be no numbness in joints. This is of great importance to patients who have a benign tumor. The patients, suffering from asthma should also wear a lightweight orthosis, because it prevents them from excessive physical strain. These examples show how that orthopedists should carefully study the patient’s physical state.
Verification
The client’s ease of mobility and absence of complications would indicate that the orthosis was appropriately designed. Decreased pressure on infected areas as well as reduced pain will also show that the treatment mode is suitable for the patient. General progress such as increased activity is the most reliable indicator of the effectiveness of the design. It should be noted that follow-up assessments during three months. An orthopedist should pay special attention to the skin condition and pain measurement. These are the criteria, which help to assess the effectiveness of treatment mode.
Conclusion
This paper has addressed several important moments of clinicians’ work. First, a physician should be knowledgeable not only in orthopedics but in other varies as well. Secondly, he/she must pay special attention to the symptoms of various diseases, as this information can influence the treatment mode. Finally, an orthopedist must have well-developed observational skills in order to assess the patient’s physical condition.
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